Stanford’s Abraham Verghese has a wonderful perspective piece in the current NEJM.
With the advent of electronic information systems in hospitals, today’s medical residents spend more time in front of computer monitors instead of talking to patients.
Dr. Verghese coins the term the “iPatient,” where “emergency room personnel have already scanned, tested, and diagnosed, so that interns meet a fully formed iPatient long before seeing the real patient. The iPatient’s blood counts and emanations are tracked and trended like a Dow Jones Index, and pop-up flags remind caregivers to feed or bleed.”
That would be funny if it wasn’t so true.
Without corroborating data with physical findings, this often leads to imprecise observations. Whether this can lead to unnecessary testing is unknown, although “in a health care system in which our menu has no prices, we can order filet mignon at every meal.”
Hospitals are increasing patient turnover rate, and there’s more pressure than ever for teams to reduce the length of hospital stay. This means faster discharges, and an incentive to expediently order more tests rather than spending the time to see and talk to patients.
The result will be a generation of physicians who place no importance in the physical exam, and a scenario where “bedside skills have deteriorated as the available technology has evolved.”
Related posts:
- How the physical exam can affect the doctor-patient relationship
- Physical exam findings on YouTube
- Are doctors finding the physical exam useless and obsolete?
- The privilege of being at a patient’s bedside
- MRI vs the physical exam
- The dying art of the physical exam
- Surprising physical exam findings
{ 5 comments }
another big so what posting. is there any evidence from good randomized studies that ipatients do any worse that those with doctors hovering around them? maybe this has more to do with doctors’ needs to appear several time an hour as “great healers” rather than mere technicians.
Without corroborating data with physical findings, this often leads to imprecise observations. Whether this can lead to unnecessary testing is unknown,
If you do not see the patient, how do you know that what you are ordering is relevant? How do you know if you should be ordering something else?
If you have an a patient with acute shortness of breath, refuses to lean back, because it makes breathing worse, very hypertensive, . . . do you order a BNP before seeing the patient? (Of course, this is not to imply that the BNP is useful for any competent ED physician.)
The AHA did not even include, Treat the patient, not the monitor, in the most recent ACLS publication. Perhaps this is to avoid offending the video game practitioners.
Anonymous,
You make a good point. I do not know of any studies comparing outcomes. I have seen plenty of anecdotal cases of misdiagnosis/mistreatment due to a focus on the equipment, rather than the patient. I would be surprised if the research did not show worse outcomes both physically and financially. This appears to be an area that could use some good objective research.
Very much agreed. The touch and ability to reason/assess is the skill we appreciate and value in physicians.
“. . .result will be a generation of physicians who. . “
Will be? Already there. I do a lot of QA work and the most consistent, indefensible quality problems are a simple result of not examining patients and taking a history. It is a problem with older docs as well as younger but more so with the latter and they are more prone to be unapologetic about it. The older guys at least are embarrassed that they didn’t look or ask. Some of the newbies think that their job is to work from the data in the chart and that the inadequacy of that data is someone elses responsibility.
Comments on this entry are closed.